Key result
In elderly patients operated on for hip fractures, an ASA score of ≥3 significantly increased mortality risk (HR 1.83) compared to lower scores, alongside other predictors like older age, male gender, and lower hemoglobin.
Why the study?
The study aimed to investigate the effects of demographic and perioperative modalities on mortality and compare mortality rates between different implants in elderly patients operated on for hip fractures.
What are the risk factors affecting mortality, and how do different surgical implants compare regarding mortality in elderly patients operated on for hip fractures?
Observational (n=314)
No
What are the risk factors affecting mortality, and how do different surgical implants compare regarding mortality in elderly patients operated on for hip fractures?
Hazard Ratio: 1.83 (95% CI 1.26–2.65)
p-value: p=0.002
In elderly patients with hip fractures, mortality is high and strongly predicted by age, male gender, lower hemoglobin, higher ASA scores, and multiple comorbidities, with similar mortality observed between long-stem and standard-stem hemiarthroplasty.
Emphasizes preoperative risk stratification in elderly hip fracture patients; leaves open whether implant type affects mortality.
OBJECTIVE: The aims of this study were (1) to investigate the effects of different demographic and perioperative modalities on mortality rates and (2) to compare mortality rates between different implants in elderly patients operated on for hip fractures. METHODS: In this retrospective study, a total of 314 patients who were operated on for hip fractures were included study. Patients were then divided into four groups based in their implant types: long-stem cementless bipolar hemiarthroplasty (n = 124; 102 female, 22 male; mean age = 84.2 ± 6.4 years), standard-stem cementless bipolar hemiarthroplasty (n = 74; 48 female, 26 male; mean age = 83.5 ± 6.9 years), antegrade intertrochanteric nail (n = 61; 35 female, 26 male; mean age = 78.5 ± 6.8 years), and total hip arthroplasty (n = 55; 34 female, 21 male; mean age = 72.5 ± 4.3 years). Data including gender, age, duration from injury to surgery, American Society of Anesthesiologists (ASA) score, comorbidities, use of antiplatelet agents, Barthel Index of Activities of Daily Living, type of anesthesia, operation time, preoperative hemoglobin values, blood transfusions given, duration of hospital stay, complications, and type of fracture were recorded. RESULTS: Overall, the mean follow-up was 36.5 (range = 0 - 107) months. The overall mortality rate was 53.2%. The median survival duration was 44.2 ± 5 months (range = 34.3 - 54). Survival rates were found significantly different among the groups (P = 0.001). In the first three years postoperatively, the mortality rate was higher in the standard-stem bipolar hemiarthroplasty group, but in the long-term follow-up, the long-stem bipolar hemiarthroplasty group exhibited the higher mortality rates. It was observed that some parameters had statistically significant effects on the mortality rates. Male gender, higher age, lower hemoglobin values, increased number of blood transfusions, ASA scores ≥3, the existence of ≥ 3 comorbidities were found as main predictors of increased mortality rates. CONCLUSION: The results of this study have shown that age, gender, preoperative hemoglobin levels, ASA scores, and comorbidities are significant factors affecting mortality in elderly patients operated on for hip fractures. Long-stem cementless bipolar hemiarthroplasty appears to show similar rates of mortality with standard-stem cementless bipolar hemiarthroplasty. LEVEL OF EVIDENCE: Level III, Therapeutic Study.
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Biçen et al. (2021) conducted an observational in Hip fractures (n=314). ASA score ≥ 3 vs. ASA score < 3 was evaluated on Mortality (HR 1.83, 95% CI 1.26-2.65, p=0.002). In elderly patients operated on for hip fractures, an ASA score of ≥3 significantly increased mortality risk (HR 1.83) compared to lower scores, alongside other predictors like older age, male gender, and lower hemoglobin.
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